Essentials of Clinical Neurology: Evaluation Of Common Neurologic Signs And Symptoms

Cerebrovascular disease (stroke) is a severe, common and expensive disorder. It is third most frequent cause of death and leading cause of adult disability. Of the 750,000 people who suffer stroke annually, 170,000 will die due to stroke. Fifty percent of hospitalized neurological patients suffer stroke. There are 3.5 million stroke survivors in this country. Many do not regain functional or vocational independence. The good news is that there has been a recent decline in stroke incidence mortality, probably due to improved risk factor control; for example, improved blood pressure control, better control of diabetes mellitus and dyslipidemia with newer medications, smoking cessation programs, better diet, more exercise and avoidance of bad habits e.g., illicit drugs, alcohol use (Box 10-1). As better control of hypertension occurs, the incidence of hypertensive cerebrovascular disease (e.g. hypertensive crisis, lacunar infarcts intracerebral hemorrhage) has decreased. On the other hand, with more frequent use of CT and MRI, the incidence of silent unrecognized stroke detected during life has increased; previously these vascular lesions would have been detected only at autopsy. Based upon CT and MRI criteria for stroke diagnosis, there are estimated 11 to 22 million unrecognized (silent) strokes. There is a 35% risk for stroke recurrence after initial symptomatic stroke and these patients may develop neurologic and mental disability (vascular cognitive impairment) from the cumulative effect of these strokes.